Is the Telemedicine System Effectively Working in Okinawa?

Transcription

1 Is the Telemedicine System Effectively Working in Okinawa? Ichiro Kukita 1), Kouji Nakamura 1), Yuichiro Tamaki 1), Yasunori Hanamura 2), Katsuhiko Yokota 3) Hiroshi Yasuda 3) and Hirotsugu Matsumoto 4) 1) Department of Emergency Medicine, Graduate School and Faculty of Medicine, University of the Ryukyus, 2) Yonaguni Municipal Clinic, 3) Center for Collaborative Research, University of Tokyo (Tokyo Denki Univ.), 4) Okinawa Prefectural Nanbu Medical center & Children s s Medical Center

2 <Background-1> Okinawa Prefecture; Geography: Islands: - Main island - 2 middle-sized islands (Miyako( and Ishigaki) - 38 small-sized sized remote islands Area:- 1,000 km from east to west km from south to north Population: Total population: 1.37 million (Okinawa Prefecture) Distribution: 1,240,000 (main island) 130,000 (2 middle sized islands and 38 remote islands)

3 Prefectural Hostpitals at Ishigaki and Miyako Clinics at 20 out of 38 remote islands Miyako Ishigaki (Modified Figure form HP of Okinawa Prefectural Chubu Hospital) Yonaguni

4 <Background-2> No. of Doctors: per 1,000 (Japan) - 2,680 doctors, 1.96 per 1,000 (Okinawa pref.) doctors, 1.47 per 1,000 (middle and small-sized sized islands) Hospitals/Clinics: - Prefectural Hostpitals at Ishigaki and Miyako - Not covering all medical specialties - Clinic at 20 out of 38 remote islands - Only one doctor is assigned

5 <Background-2> - Clinic at 20 out of 38 remote islands - Only one doctor is assigned

6 <Background-3> Issues identified for remote island clinic doctors: 1. Have to cover all medical specialty 2. Less chance of accessing to the up-to to-date medical knowledge and training 3. On call 24/7 4. Emergency patients 5. Sense of isolation and insecurity without peer doctors 6. Human relations with island residents Solution: Enforce IT (telemedicine system) - solve the above issue 1 and 2 - alleviate 5 Emergency Aeromedical transportation - alleviate 4

7 < Objective > Evaluate the status-quo - Telemedicine system Opinion of concerned doctors Evaluate the status-quo - Aeromedical transport (critical patients) - Synergy between telemedicine system and aeromedical transport

8 < Methods > - Literature searching - Interview - On-site study - Questionnaire

9 < Results-1 1 > Status-Quo Telemedicine - ISDN based TV conference system

10 ISDN based TV conference system is installed in 2000 POLYCOM (R At Okinawa Prefectural Chubu Hospital

11 < Results-1 1 > TV Conference System ISDN capacity is not enough to support the system - Evaluated on July 20, voice interuption + screen freeze

12 < Results-1 1 > TV conference system - ISDN based TV conference system is installed - ISDN capacity is not enough to support the system - ADSL infrastructure is under construction

13 Status-Quo Telemedicine Consultation (Intranet/Internet Consultation System) -Sometimes -effective

14 < Results-1 1 > Consultation (Intranet/Internet Consultation System) - Sometimes effective - but Not used as expected - one consultation via E conference per day (average) - mainly Dermatology and Orthopedics - Systematic doctor network to carry out the telemedicine has not been established yet

15 < Results-2 2 > - Questionnaire

16 Result of questionnaire asking if supporting to enhance the TV conference based telemedicine system. 27% 27% 46% positive negative not replied

17 < Results-3 3 > Status-Quo Aeromedical Transport

18 Aeromedical transport in Okinawa ー Emergency transport from isolated island ー

19 Naha-Daitojima Distance: 360 km FLT Time: 1.5H by helicopter Naha-Ishigaki Distance: 420 km FLT Time: 1.75 H By helicopter

20 Aircrafts used for Transportation CH-47JA Maximum capacity: 24 stretchers UH-60JA

21 Aeromedical Transport in Okinawa 1.Started in 1972 by Ground Self Defense Force More than 7000 times. 24/7 on call times in 2005 by Japan Coast Guard and Ground SDF 101 by Japan Coast Guard 230 by Ground SDF 3. Not always accompanied by a doctor 4. Fatal aircraft accidents (1990 and 2007)

22 Transportation per disease type Cardiovascular Neurology Trauma Gastrointestinal Respiratory Gynecology Others (2004) (%)

23 Doctor Accompanying Ratio in Kagoshima and Okinawa % 100% 100% 100% 100% Kagoshima Pref % % Okinawa Pref % 28.7% 31.3%

24 Aeromedical Transport ー Risk and Restriction ー 1.Risk - Aircraft accident - Vibration -Noise 2. Restriction - Grounding due to weather condition

25 -Synergy - -No linkage between the telemedicine system and the aeromedical transport - Not enough capacity to transmit CT images for transportation decision - Communication is made via fax and telephone The following information and data will enhance the quality of emergency patients treatment - Severity of patient - Vital sign - Consciousness level - Images (CT, X-ray) - Level of emergency (triage)

26 < Discussion-1 1 > Issue summary (telemedicine system in Okinawa) 1. ISDN capacity 2. Lack of a doctor network 3. High maintenance cost (no data shown) 4. Negative attitude of doctors towards IT system

27 < Discussion-2 2 > Issue summary (aeromedical( transport) 1. Lack of communication - remote clinic doctors and main island doctors 2. Central management - Information - Medical team assignment - No fixed members at this moment. - Information is not centrally managed - Arrangements are not centrally made

28 < Conclusion-1 > The telemedicine system is not effectively working in Okinawa. - Not enough of systematic doctor network - ISDN : capacity is not enough - Negative mindset of doctors as the result of the less effective status-quo

29 < Conclusion-2 > Strategic approach is needed - Create systematic doctor network - Strengthen the hardware infrastructure Shift from ISDN to ADSL - Enlighten those concerned From negative to positive mindset Our action - We made Okinawa Telemedicine Promotion Conference (OTPC). - OTPC acts collaborative scientific research voluntarily.